What women with (undiagnosed) sleep apnea want their therapist to know:
Attn Fellow Therapists:
Have you ever had a client say “I’m so anxious when I first wake up… but I have no idea why?” The client describes being dead asleep moments before jolting awake with stress, possibly gasping for air, despite there not being any major stressors. If this sounds familiar, keep reading.
I attended a training recently where a phenomenal patient advocate Emma Cooksey shared her years-long journey to getting a correct diagnosis of sleep apnea.
Unfortunately, it’s not uncommon to take a lengthy period of time to get a correct diagnosis, especially for women.
As a mental health therapist specializing in sleep disorders, I often hear clients who have had to wait years or, often, decades for a correct sleep disorder diagnosis and treatment.
Mental health therapists, who often have the most information about client’s lives, have a golden opportunity to reduce the treatment delay.
Click here for a free on-demand training for therapists: Insomnia Assessment and Prevention
First let’s talk Obstructive Sleep Apnea (OSA), what is it?
It’s a type of sleep apnea where the airway collapses multiple times per night.
This has a huge impact, as you might imagine, the body is deprived of oxygen which can lead to many negative effects and symptoms when left untreated.
(Learn more at Project Sleep: https://project-sleep.com/sleep-apnea-squad/)
Sleep Apnea is a commonly missed diagnosis (and therefore left untreated) in women… but why?
Many doctors don't screen for this in the first place and when they do, it doesn’t capture women’s experiences. The screenings were developed for men (as many things in healthcare, women were left out).
Another unique factor is women in the perinatal process and as caregivers to young children often have their sleepiness dismissed as part of that season of life.
Emma’s fatigue was dismissed as part of the peri-natal process during her first pregnancy. After being diagnosed and treated, in her second pregnancy, the positive impact of the treatment on function and energy levels highlighted that it wasn’t just the season of life.
An emerging area of research is treatment of OSA in pregnancy. In other words, it wasn’t just a matter of “Grin and bear it”, she had a real treatable medical issue that went unaddressed and had reduced quality of life and increased health impacts. This was totally unnecessary and could have been caught sooner.
How do mental health therapists come into play?
Having a basic understanding of sleep apnea, what to look out for and where to refer can be key to treating this condition. Otherwise women go years, or decades without enough oxygen each night.
Emma shared a story of going to therapy and saying to the therapist something like “I’m so anxious when I wake up.” The therapist asked “What are you anxious about?” and she truly had no idea.
In retrospect, she reflected that this was a physiological response to essentially not breathing for a long period of time then jotting awake gasping for air.
Part of Obstructive Sleep Apnea can be waking up flooded with adrenaline. The body is in a state of stress without oxygen. As therapists, we always want to be looking for a physical cause of symptoms to catch, and this story is a great illustration of why it is so important for us to watch out for a physical cause of anxiety symptoms.
You can play a key role in women’s journey to a correct diagnosis. Of course not everyone with the experience of waking up anxious has OSA and it’s not our role to diagnose OSA, you can play a key role in connecting to specialty care.
Here are some OSA red flags to look out for:
Daytime Sleepiness (often dismissed in women “we’re all tired”)
Snoring (even if it doesn’t feel that unusual compared to peers)
Using the bathroom multiple times in the night
Intense morning headaches
Waking up at night
Clients with undiagnosed sleep apnea wish providers would ask questions:
Women are often taught to dismiss their own symptoms, even by healthcare professionals. Many of the symptoms have been minimized so much they may not even think to bring it up.
There can also be a ton of shame around these symptoms and clients can get good at faking alertness and staying awake- they’ve had to in order to get by.
Often they have already talked to a doctor about it, gotten bloodwork and everything came back negative (but PCPs don’t have the equipment to test for sleep apnea) so that further fuels the delay to a correct diagnosis.
My client is showing some signs of OSA, what can I do now to help?
Check out the “Could I have sleep apnea?” resources https://project-sleep.com/sleep-apnea-squad-could-i-have-sleep-apnea/
As well as the whole suite of resources from Emma and Project Sleep on OSA
https://project-sleep.com/sleep-apnea-squad/
Most major hospital systems have sleep centers that offer this testing.
Reach out to me for a free peer consultation. I love helping guide fellow therapists through the world of behavioral sleep medicine.
Email me at Hello@BodyMindAllianceCC.com or check out my provider FAQ page
Potential Barriers and fears clients might have about pursuing a diagnosis and treatment:
Worries about doing in-lab studies: There are also home tests too if going in for a study is a concern.
Fear around the CPAP device/perception of it not being very feminine or shame and stigma around this:
There are many treatment options for sleep apnea, the most common is the CPAP but keep in mind there are a variety of treatment options such as oral devices, and therapies. There is also a new medication very recently developed. Every person will have different viable treatment options. Check out project sleep’s resources on reducing shame and treatment options. https://project-sleep.com/sleep-apnea-squad/
Dismissal from non-specialists. Education about Sleep Apnea isn’t sufficient, especially for generalists in healthcare. Many women are dismissed as not having sleep apnea simply because they are not men or because they’re young and/or thin.
Remember you can help women get an important medical condition treated and help them move from seeing sleepiness and their symptoms, not as a personal failing, but a treatable medical condition.
Check out Emma’s podcast, Sleep Apnea Stories
About the Author:
Kasryn is a licensed therapist specializing in behavioral sleep medicine. Dedicated to helping exhausted adults break the cycle of sleepless nights. Including women with both diagnosed and undiagnosed sleep apnea. The first step is a free consultation.
Kasryn Kapp, LPC (She/Her)